Is it just a Lind is 300 degrees and a Toupet 270 degrees or are there other technical modifications to the posterior partial wraps ?
Hi Ewen,
While Toupet's fundoplication is described in many operative surgery texts (all of which invariably refer to the original publication by Toupet written in french), I was not able to find clear descriptions for Lind fundoplication.
A very recent review of Laparoscopic Lind fundoplication by Shapey et. al. describe the procedure as a partial 300 degree posterior wrap which fits the definition you have provided.
It is interesting to note however, that the reference article by J F Lind in this publication describes a slightly different technique.
In the first page preview of the original article (attached below), available on JAMA website, the technique is described and illustrated as follows.
1. Repair of hiatus hernia with interrupted sutures.
2. Gastric fundus wrapped posteriorly and sutured to medial (right) wall of esophagus.
3. lateral (left) wall of esophagus sutured to the wrapped fundus.
4. Fundus wrapped anteriorly and sutured to the medial (right) wall of esophagus. with a very small visible interval between anterior and posterior suture lines.
So in essence it is much more than a 300 degree wrap with an additional fixation of the posterior wrap to the lateral esophageal wall in the original description.
regards, raza
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The two techniques represent different concepts. Lind is just modified Belsey. No conceptual difference. However Toupet procedure is different think. Also it is not 270 degree wrap and I really do not know from where that mistake comes from. Probably the article below will be helpful to familiarise with the Toupet's original concept:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422477/pdf/20020400s00019p591.pdf
Largest conceptual difference is that the Lind procedure is a true anterior posterior wrap relative to the angle of His and greater curve. A Toupet is oriented/ canted to build a more posterior groove and less than an anterior groove.